November 15, 2014

Health Care on the Chopping Block?

Just a couple of days after Sen. Mitch McConnell (R-KY) and Rep. John Boehner (R-OH) became leaders of the 114th Congress, they declared open season on health care for the poor and middle class. Their starting salvo was announced in a Wall Street Journal op-ed in which they began with eliminating benefits for workers employed fewer than 40 hours a week. In typical GOP-speak, they said that this change would provide employees with “more hours and better pay.” In 2013, 43.8 percent of all workers, 60.9 million people, were employed at 40 hours or more. The question is whether members of Congress would lose their insurance if health care guidelines change. The people wanting the increase in hours worked to get health care, congressional legislators, work about two days each week. They seem to be saying that they would work harder if they didn’t get health care unless they worked five days a week.

Conservatives have been jumping with joy ever since Jonathan Gruber, self-proclaimed architect of the Affordable Care Act, proclaimed that it was the “stupidity of the American voter” that allowed the bill to become a law. Far from being an “architect,” Gruber served as a consultant to produce cost estimates of provisions and giving technical advice based on his overseeing similar reforms in Massachusetts. According to Gruber, Democrats kept the Congressional Budget Office from scoring the mandate as a tax and hide the provision that young and healthy beneficiaries would subsidize premiums for the sick.

Scoring the mandate as a “tax” would not have changed the estimate of increasing revenue by $4 billion in 2016 and approximately $5 billion per year for the next eight years. There was also no lack of transparency about everyone, healthy or sick, paying into the insurance, and the media incessantly covered this fact. AP reporter Erica Werner clearly explained that premiums varied only on age, geographic area, and tobacco use. The president told AARP in 2009 before the law was passed:

“[Y]ou get the healthy and the young people alongside the not-so-healthy and the older people. But we’re all kind of spreading our risk, because each of us don’t know at any given time what might happen.”

Gruber also complained that the law does little or nothing to control health care costs. Yet four years after the act passed, projections for health care in 2019 is $500 billion less than projected at the time that it passed. As costs increase in many other areas, a study of 48 urban areas shows an average 0.2 decrease in the “silver” plans. Costs seem to be all over the place from an increase of 28 percent in Anchorage (AK) to a reduction of 24 percent in Jackson (MS). At the same time, the government paid $104 billion less in 2014 subsidies than originally predicted. The country has seven million more people than insured before ACA, the government pays less than predicted, and the rise in healthcare costs has dramatically slowed.

Gruber has apologized for his statements, saying that they were just “off the cuff” at academic conferences. It may not be enough to save the millions of dollars that he was scheduled to make. Eight states hired Gruber to help design their health exchanges after he banked nearly $400,000 in 2009 through contracts with the Department of Health and Human Services. He and a few colleagues had state contracts for $1.6 million over seven years from Michigan ($481,000), Minnesota ($329,000), Vermont ($400,000) and Wisconsin ($400,000). He also advised Colorado, Connecticut, Maine and West Virginia.

Because of ACA’s requirement that insurers must spend at least 80 percent of premium costs on medical care, 6.8 million families are getting average rebates of $80 totaling almost $2 billion. That’s one reason premiums are being lowered. Subsidies are the other reason. If the Supreme Court denies these subsidies in states without state exchanges, people can see their insurance premiums increase by about 75 percent.

As people line up to register for health care this week, the U.S. Supreme Court may join the conservatives in Congress to kill off the law—and many people at the same time. Paul Krugman called the lawsuit to be argued this year as death by typo. The Supreme Court is set to determine if the word “state” in one sentence of the 2200-page law means that poor people won’t receive subsidies in the states that don’t have their own government-run marketplace. Krugman wrote:

“Judges who support this cruel absurdity aren’t stupid; they know what they’re doing. What they are, instead, is corrupt, willing to pervert the law to serve political masters.”

Over two decades ago, the conservatives supported single-payer health insurance, but that was before the Democrats accepted the idea. When Congress started working on the plan in the president’s early years, the Democrats attempted to mollify the GOP by incorporating their ideas into the law. After the GOP pushed the Democratic legislators in a corner, the law received only one GOP vote, a representative. Current problems show that single-payer health care would be the best for almost all the people in the United States.

Megan Rothbauer’s $50,000 bill is one example of why the U.S. needs a single-payer plan. Up-to-date on her insurance payments, the Wisconsin woman went into cardiac arrest and was unconscious when she was rushed to a hospital. The place where the ambulance took Rothbauer, 30, didn’t take her insurance although one three blocks away did. Unfortunately, she wasn’t able to tell them where they should take her. Without the Affordable Care Act, she would have owed another $100,000. A single-payer plan would have kept her from the possibly of becoming destitute, but Rothbauer is now facing bankruptcy. Blue Cross Blue Shield stated that the fault is with the hospital. The hospital stated that they could have charged her more but didn’t. Medical experts indicate that this is a common situation.

Even knowing what hospital is in a network doesn’t always help. When probate attorney Jeffrey Craig Hopper was smashed in the face with a baseball while coaching Little League in Austin (TX), his wife made sure she took Hopper to a hospital that is part of their insurance network. The ER doctor sent the couple a bill for more than $700; he could do this because he was outside the approved network of physicians. Again, this is fairly common: in more than half of Humana’s Texas hospitals, none of the ER doctors is within Humana’s network. The same situation goes for almost half the Texas hospitals with United Healthcare insurance and about a fifth of Blue Cross-accepting hospitals. Preparing for the next emergency, Jennifer Hopper couldn’t find even five doctors who would take their insurance at hospitals her plan uses in Austin.

For the fifth consecutive year, the United States, the richest nation in the world, ranked last in industrialized nation’s health care systems. The only industrialized nation without universal health care, the U.S. has the highest percentage of U.S. residents not seeking necessary medical care because they can’t afford it. Thirty-seven percent of Americans said they didn’t fill a prescription, visit a doctor, or get recommended medical care because they worried about the cost compared to only four percent of people in the United Kingdom.

The United States has the highest infant mortality and deaths possibly preventable with access to effective health care. It’s also at the bottom of “efficiency” because of the time and money spent dealing with insurance administration, lack of communication among health care providers, and duplicative medical testing. In “equity,” the 39 percent of adults with below-average incomes in the U.S. who could not visit doctors because of costs puts the U.S. also at the bottom, compared with the less than one in ten who have the problem in the UK, Sweden, Canada, and Norway. People in the U.S spent $8,508 per person on healthcare in 2011 compared to $3,406 per person in the UK, but the higher cost of health care in the U.S. doesn’t equate to better care.

The data that put the United States last was collected before ACA went into effect. Even if the Supreme Court destroys “Obamacare,” the nation many have a brief shining time of health care for residents in Democratically-controlled states. Even so, six million of the poorest residents lack health care if GOP states refuse to expand Medicaid. A negative Supreme Court decision could triple or quadruple that number.

In Oregon, Monica Wehby, the GOP candidate who just lost to Sen. Jeff Merkley, wants to be boss of the Oregon Health Authority. The day after the election, she called newly re-elected Democratic Gov. John Kitzhaber to ask for the job. The agency runs the state’s Medicaid program for 300,000 low-income Oregonians and may also administer Cover Oregon, the health insurance exchange, which Wehby wants to destroy. Her campaign slogan was “Keep Your Doctor. Change Your Senator.” Before she ran for the senate, she starred in a 2009 nationwide commercial warning about the plan’s dangers. The job would also give her a serious hit in salary: in 2013, she made $861,479 as a pediatric neurosurgeon for Legacy Health Systems, and the previous OHA director made $173,000. She says that she just wants to “stay involved.”

One question in the Supreme Court argument about ACA is whether the business-friendly justices will go against the money-makers in the insurance and health industries. They’re making more money, and they like it.

As in the past couple of years, the Supreme Court is addressing voting rights, health care, and possibly marriage equality. Millions of people will be waiting until their pronouncements next June.